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July 3, 2008
Dear Friend,
We’re constantly being bombarded with recommendations to get multiple medical tests. And while a handful of conventional screening tests are valuable and do save lives, others are widely overused and unreliable—and some are downright harmful. In this update I want to give you an overview of which tests to seek out as well as which ones you should avoid.
Don’t skip these medical tests
—they could save your life!
I’ve been practicing medicine for more than 30 years now, and I’ve seen lots of screening and diagnostic tests come and go. But these are the ones I strongly believe in, and recommend to my patients at the Whitaker Wellness Institute.
- An Annual Blood Workup: A simple blood test can reveal a tremendous amount about your heart attack and diabetes risk, immune and liver function, and more. I recommend getting a complete blood workup annually, and more often if you’re monitoring a specific condition.
- Regular Blood Pressure Checks: According to the American Heart Association, as many as 72 million Americans have hypertension, 28 percent of them are unaware of it, and a large percentage of those who have been diagnosed have poor blood pressure control. This is why I recommend that everyone over 35 have their blood pressure checked regularly. You should monitor your blood pressure at home on a regular basis, in addition to having it checked by your doctor.
- Noninvasive Tests of Heart Function: Because heart disease is the leading cause of death in the United States, it is important to evaluate the health of your cardiovascular system. While blood tests can help, sometimes we need more direct information about the heart. The best, least invasive methods of getting this information are the exercise stress test and the echocardiogram.
- Bone Density: Although I don’t recommend bone mineral density screening for everybody, I think this test is important for postmenopausal women who are at greatest risk of osteoporosis. The best, most reliable way to determine bone density is with a Dual Energy X-ray Absorptiometry (DEXA) scan. This test is quick, painless, noninvasive, and quite safe—although it does expose you to a small amount of radiation.
- Proven Cancer Screening Tests: As you’ll see below, I’m not a fan of some of the most popular cancer screening tests. However, there are two tests that have withstood the test of time, and I do recommend them to some of my patients. They include the Pap smear (a screening test for cancer of the cervix), and colorectal cancer screening.
Tests that often “scare the socks off people”—
leading to unnecessary procedures and surgery
Now let’s move on to four very common tests that may not live up to their promise of saving lives. Instead, they scare people, funneling them into unnecessary tests and surgical procedures. If you are recommended to have these screenings, I urge you to get all the facts—and tread cautiously.
- Mammograms: Not All They’re Cracked Up to Be: Mammography is supposed to save lives by detecting breast cancer early. But while it’s true that some studies have shown mammography can reduce the number of deaths from breast cancer for 50- to 69-year-old women, there is little evidence to support its use in women under the age of 50 or over the age of 65 or 70. False readings are common—often leading to unnecessary repeat tests and surgeries. Plus, mammograms themselves expose you to radiation.
So, what should you do? The decision of whether to have a mammogram is very personal—and something you should discuss with your doctor. One possible alternative to mammograms is thermography. What I recommend for most of my patients is yearly clinical breast exams by a well-trained physician or other health care professional, along with monthly breast self-examinations.
- The Pitfalls of PSA Testing: Prostate cancer is the second leading cause of cancer death in men—and it’s skyrocketing in older men. That’s why it’s recommended that men ages 50 and older get a prostate specific antigen (PSA) test which measures a blood component that rises in the presence of prostate cancer. The problem, though, is that PSA can also rise with some noncancerous conditions, such as prostatitis (inflammation of the prostate). In fact, it is estimated that half of all PSA results are false positives—and false negatives occur too.
So what should you do? Beginning around age 50—or younger if you’re African American or have a family history of prostate cancer—get an annual digital rectal exam. If a tumor can be felt in the prostate, further investigation is indicated. If you’d like to have annual PSA tests to monitor PSA velocity, fine. But do not jump into treatment based solely on PSA readings. - Angiography: Gateway to invasive procedures: Angiography, or coronary catheterization, involves injecting dye into a coronary artery, followed by X-ray pictures to determine blockages. Although it’s often considered the “gold standard” in diagnosing arterial blockages, it’s actually far from precise. Numerous technical problems can undermine the accuracy of this test, leading to false negatives and false positives. Plus, this is one test where human interpretation of the results can vary widely, by as much as 50 percent depending on who’s reading the test results.
So what should you do? If your doctor tells you to have an angiogram, consider it carefully. And if he or she tells you that you cannot be treated unless you have an angiogram, don’t buy it. Treatment decisions should be based on your entire clinical condition, which can often be obtained by efficient, advanced, noninvasive testing. Before submitting to angiography, get a second opinion—a true second opinion from a physician whose livelihood does not depend on the propagation of such procedures. - Full-Body CT Scans: You may have heard a commercial on the radio or seen ads in your paper touting a painless, noninvasive test to predict your risk of heart disease and cancer. These very provocative ads often end with the testimonial of a grateful patient who, thanks to this test, was “fortunate” enough to have had a biopsy or angiogram and angioplasty—leaving him and many listeners convinced that the CT scan saved his life. Without getting into a whole lot of detail, in my opinion the science behind the CT scan isn’t sound. It’s plagued with inaccuracies, and exposes you needlessly to harmful levels of radiation.
So what should you do? Avoid full-body CT scans. There is simply no evidence that this type of preemptive, pre-symptomatic screening saves lives. In fact the FDA, the American College of Radiology, and the American Cancer Society all caution against full-body scans for this very reason.
***
As you can see, diagnostic and screening tests are a mixed bag. I’m not saying that all screening tests are worthless, nor am I telling you to never have any of these tests. That choice is up to you.
But the more you know about your health care, the better off you are. An excellent way to stay educated and keep up with all aspects of your medical health is in my monthly newsletter, Health & Healing. In the August issue I’ll be discussing a proven, noninvasive therapy that has the power to actually reverse heart disease. I’ll also share with you some little-known therapeutic benefits of water. If you’re not already a subscriber, you can click here to find out more.
Here’s to your health,
Julian Whitaker, MD
P.S. Be sure to ask for a copy of the results of any medical test you take to keep in your file at home. If you need clarification on something, ask your doctor or nurse. The bottom line is you need to be a proactive patient—your health depends on it!
In Today’s Health Update
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